脓毒性休克患者对三线血管紧张素-II 和肾上腺素的临床反应:倾向匹配队列研究。

IF 2.3 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Annals of Pharmacotherapy Pub Date : 2024-10-01 Epub Date: 2024-02-01 DOI:10.1177/10600280231226132
Caitlyn R Blankenship, Kevin D Betthauser, Laura N Hencken, Julie A Maamari, Jenna Goetz, Bria D Giacomino, Gabrielle A Gibson
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引用次数: 0

摘要

背景:对于接受去甲肾上腺素和血管加压素治疗的脓毒性休克患者,合适的第三线血管加压素尚不清楚。血管紧张素-II(AT-II)与传统上用于脓毒性休克的血管加压素相比,具有独特的作用机制:本研究旨在比较脓毒性休克患者使用三线 AT-II 和肾上腺素的临床疗效和安全性:2019年4月1日至2022年7月31日期间,对重症患者进行了一项单中心回顾性队列研究。倾向匹配(2:1)分析比较了接受三线 AT-II 的成人脓毒性休克患者和在去甲肾上腺素和血管加压素之后接受肾上腺素的对照组。主要结果是三线血管加压素启动 24 小时后的临床反应。此外,还对其他疗效和安全性结果进行了调查:23例AT-II患者与46例肾上腺素患者进行了比较。47.8%的AT-II患者在24小时后观察到临床反应,而肾上腺素患者为28.3%(P = 0.12)。院内死亡率(65.2% vs 73.9%,P = 0.45)、心律失常(26.1% vs 26.1%,P = 0.21)和血栓栓塞(4.3% vs 2.2%,P = 0.61)在组间没有统计学差异:结论和相关性:与肾上腺素相比,脓毒性休克患者使用AT-II作为三线血管加压药并不能显著改善24小时时的临床反应。尽管本研究的临床观察结果不足以检测出有意义的差异,但仍值得考虑并进一步研究将AT-II作为脓毒性休克的三线血管加压药。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Response to Third-Line Angiotensin-II vs Epinephrine in Septic Shock: A Propensity-Matched Cohort Study.

Background: The appropriate third-line vasopressor in septic shock patients receiving norepinephrine and vasopressin is unknown. Angiotensin-II (AT-II) offers a unique mechanism of action to traditionally used vasopressors in septic shock.

Objective: The objective of this study was to compare the clinical efficacy and safety of third-line AT-II to epinephrine in patients with septic shock.

Methods: A single-center, retrospective cohort study of critically ill patients was performed between April 1, 2019 and July 31, 2022. Propensity-matched (2:1) analysis compared adults with septic shock who received third-line AT-II to controls who received epinephrine following norepinephrine and vasopressin. The primary outcome was clinical response 24 hours after third-line vasopressor initiation. Additional efficacy and safety outcomes were investigated.

Results: Twenty-three AT-II patients were compared with 46 epinephrine patients. 47.8% of AT-II patients observed a clinical response at hour 24 compared with 28.3% of epinephrine patients (P = 0.12). In-hospital mortality (65.2% vs 73.9%, P = 0.45), cardiac arrhythmias (26.1% vs 26.1%, P = 0.21), and thromboembolism (4.3% vs 2.2%, P = 0.61) were not observed to be statistically different between groups.

Conclusions and relevance: Administration of AT-II as a third-line vasopressor agent in septic shock patients was not associated with significantly improved clinical response at hour 24 compared with epinephrine. Although underpowered to detect meaningful differences, the clinical observations of this study warrant consideration and further investigation of AT-II as a third-line vasopressor in septic shock.

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来源期刊
CiteScore
5.70
自引率
0.00%
发文量
166
审稿时长
3-8 weeks
期刊介绍: Annals of Pharmacotherapy (AOP) is a peer-reviewed journal that advances pharmacotherapy throughout the world by publishing high-quality research and review articles to achieve the most desired health outcomes.The articles provide cutting-edge information about the most efficient, safe and cost-effective pharmacotherapy for the treatment and prevention of various illnesses. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 14 days
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